Pilot outcome results of culturally adapted evidence-based substance use disorder treatment with a Southwest Tribe

Abstract

Introduction Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview. Methods In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment. Results Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedges’s g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = −0.66) and 5 of the 7 Addiction Severity Index domains (range of g = −0.42 to −0.98) also emerged. Conclusions Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

“…For example, evidence suggests that American Indians/Alaska Natives are more comfortable with services that integrate tribal customs, traditions, and spirituality (Venner et al, 2016; Novins et al, 2011 Spicer et al, 2007). Among Asian Americans, fear of shame or losing face has been identified as a barrier to treatment receipt (Masson et al, 2013).…”

Partnering with Native Communities to Develop a Culturally Grounded Intervention for Substance Use Disorder

“…Although evidence showing that Native communities suffer health disparities related to SUD has been demonstrated consistently for years, AI/ANs have the greatest unmet need for treatment among all ethnic groups in the United States (Chartier & Caetano, ). Furthermore, there are notable disparities in treatment access and other barriers to effective SUD treatment for AI/AN people (Greenfield & Venner, ; Rieckmann et al., ; Venner et al., ). One factor contributing to these outcomes is the paucity of empirically tested and culturally appropriate therapies available for AI/ANs with SUD (Etz, Arroyo, Crump, Rosa, & Scott, ; Greenfield & Venner, ; Venner et al., ).…”

“…Although communities profess the need for more effective SUD treatments, there is evidence of profound skepticism and resistance to the idea of evidence‐based treatments developed by non‐Native researchers for non‐Native patients being used in AI/AN communities (Calabrese, ; Gone, ; Greenfield & Venner, ; Novins et al., ; Skewes & Lewis, ; Venner et al., ). Respect for culture and tribal sovereignty is perceived to be at odds with mandates to use evidence‐based treatments, and some aspects of efficacious treatments are at odds with AI/AN cultures (Gone, , ; Larios, Wright, Jernstrom, Lebron, & Sorensen, ; Novins et al., ; Venner et al., ). As a result, most AI/ANs who need SUD treatment never receive evidence‐based treatments, and it is unclear whether these interventions would be effective for AI/AN populations even if the barriers of trust and engagement could be overcome (Novins et al., ; Venner et al., ).…”

“…Respect for culture and tribal sovereignty is perceived to be at odds with mandates to use evidence‐based treatments, and some aspects of efficacious treatments are at odds with AI/AN cultures (Gone, , ; Larios, Wright, Jernstrom, Lebron, & Sorensen, ; Novins et al., ; Venner et al., ). As a result, most AI/ANs who need SUD treatment never receive evidence‐based treatments, and it is unclear whether these interventions would be effective for AI/AN populations even if the barriers of trust and engagement could be overcome (Novins et al., ; Venner et al., ). Perhaps if evidence‐based interventions were modified to meet the needs of tribal communities, there would be greater adoption of these effective techniques.…”

A pilot randomized trial of Motivational Interviewing compared to Psycho-Education for reducing and preventing underage drinking in American Indian adolescents

“…Importantly, “cultural relevance” can be built into MI and tailored for AI/AN populations. MI may be particularly useful in AI/AN populations when cultural adaptions are made to: use AI/AN therapists, emphasize respect for the study participant’s language and spirituality, their relationship with extended family and clan, as well as their tribes’ unique history and culture (Venner et al, 2016). Several groups have developed methodology to implement MI in AI/AN populations as well as demonstrate its acceptance by AI/AN communities (Dickerson, Brown, Johnson, Schweigman, & D’Amico, 2016; Gilder et al, 2011; Venner, Feldstein, & Tafoya, 2008).…”